Symptoms

  • Patients will often report distressed breathing
  • They will report increase in distress on lying down.

 

Signs

  • Stridor is a sign characterised by a high pitched breathing sound resulting from turbulent air flow
  • Consider cause: intrinsic obstructing lesion or extrinsic compression from adjacent structure, for example thyroid.

 

Management

  • If stridor is an anticipated part of disease progression (for example head and neck cancer), prepare the patient and carer and ascertain wishes where possible.
  • Ensure wishes are documented in Advance Care Plan/ electronic Key Information Summary
  • If tracheostomy is an option arrange emergency admission for definitive procedure to alleviate obstruction
  • If tracheostomy is not an option treatment will depend on anticipated prognosis
  • If the patient is felt to be imminently dying treat any distress with midazolam 10mg IV or IM
  • Otherwise consider immediate management with corticosteroids with gastroprotection (usually proton pump inhibitor),
  • Dexamethasone 16mg orally (or IV) immediately and subsequently Dexamethasone 8mg twice daily orally (second dose before 2pm if possible). Discontinue promptly if no benefit and reduce gradually in responders.
  • In discussion with senior doctor consider nebulised adrenaline (1:1000) 1mg to 5mg driven on oxygen. Assess response and repeat if necessary.